Sarah Bernard - Academia.edu (original) (raw)
Papers by Sarah Bernard
Use of medication for challenging behaviour in people with intellectual disability
The British journal of psychiatry : the journal of mental science, 2014
ABSTRACT Medications, particularly antipsychotics, are commonly used to manage challenging behavi... more ABSTRACT Medications, particularly antipsychotics, are commonly used to manage challenging behaviour in people with intellectual disability. When the behaviour does not arise from an underlying mental illness, this is commonly off-licence and evidence of efficacy is lacking. A national audit programme would be one way to address the concerns this raises.
A Survey of Neural Tube Defect Pregnancies in North-West England
European Journal of Pediatric Surgery, 1988
The preliminary results are reported of the first eighteen months of a three year survey of NTD a... more The preliminary results are reported of the first eighteen months of a three year survey of NTD affected pregnancies in the North Western Region of England. The results are consistent with a general decline in the incidence of NTD. Prenatal screening has been available for 10 years but babies continue to be born with NTD. Supportive services are often lacking for parents having had an affected pregnancy and methods of imparting advice regarding recurrence risks have been shown to be variable and not always efficient.
Epilepsy in childhood: effects on behaviour and mental health
Introduction to Epilepsy, 2012
Mental health needs of children and young people with learning disabilities
The importance of family: a case report
Advances in Mental Health and Learning Disabilities, 2010
This case report highlights the importance of the role of the family in supporting a young person... more This case report highlights the importance of the role of the family in supporting a young person with a developmental disability. The young person discussed has a complex neurodevelopmental disorder with co-morbid physical health problems. Her family have coped with a number of events in CR's life, ensuring that she has always had their support and understanding. At the time
Parents with learning disabilities ‐ the assessment of parenting ability
Advances in Mental Health and Learning Disabilities, 2007
There is increasing awareness of the needs of parents who have a learning disability with the emp... more There is increasing awareness of the needs of parents who have a learning disability with the emphasis being on the requirement to provide ‘good enough’ parenting to their children. This paper explores these issues and considers how these parenting needs might be addressed.
Psychiatric Bulletin, 1998
The role of the psychiatrist in learning disability: How it is perceived by the general practitioner
Psychiatric Bulletin, 1994
This study assessed, by postal questionnaire, how the role of the psychiatrist in learning disabi... more This study assessed, by postal questionnaire, how the role of the psychiatrist in learning disability is perceived by general practitioners. One hundred and forty-six GPs were questioned on various aspects of assessment and management that the psychiatrist in learning disability might be involved with; 43.5% of questionnaires were returned. The resultsindicated that confusion continues. The psychiatrist was perceived as having
Obesity and Chronic Obstructive Pulmonary Disease: Is Fatter Really Better?
Canadian Respiratory Journal, 2014
Lactate Kinetics during Exercise in Chronic Obstructive Pulmonary Disease
Canadian Respiratory Journal, 1997
Clinical Investigative Medicine, Jun 1, 2007
The goal of the present study was to compare the maximum walking speed and peak oxygen consumptio... more The goal of the present study was to compare the maximum walking speed and peak oxygen consumption (VO2 peak) obtained during the 6min walk test (6 MWT) and an incremental shuttle walking test (ISWT) in a trained older population. Methods: A total of 22 older adults (16 female and 6 male) with a group mean age of 70±5.8 yr (range 58 to 79) completed the 6 MWT and ISWT within a 2 wk period. Heart rate (HR) and VO2 peak were measured during each test with a portable metabolic cart (Cosmed, K4B2). The VO2 peak, the maximum walking speed and the total distance walked measured during both tests (6 MWT and ISWT) were compared. Results: A total of 110 recordings for the VO2 peak were obtained and analyzed. Strong correlations were found for the VO2 peak and the walking speed (r=0.91 and r=0.89, respectively, for 6 MWT and ISWT). VO2 peak values obtained with the ISWT were significantly greater (P<0.05) than with the 6 MWT (21.6 ± 5.3 vs 18.9 ml/kgmin ± 4.5, respectively). There was no difference between sexes. In addition, the maximum heart rate as predicted from age during the ISWT was reached by all participants while it was not during the 6 MWT. Conclusion: Thus, the ISWT appears to a better tool to assess the maximal aerobic functional capacity in older healthy adults based on the higher VO2 peak values obtained in comparison to the 6 MWT. status. Conclusion: This cohort of patients remained remarkably stable over a 2-year follow-up period. A small loss in lean body mass was observed in some patients but this could not be associated with adverse clinical outcomes during this period.
Eligibility for home oxygen programs and funding across Canada
Canadian respiratory journal : journal of the Canadian Thoracic Society, Jan 25, 2015
In Canada, although medical insurance is generally universal, significant differences exist in th... more In Canada, although medical insurance is generally universal, significant differences exist in the provision of home oxygen therapy across the country. To systematically compare the terms of reference for home oxygen across Canada, with a focus on the clinical inclusion criteria to the programs. The authors searched the terms of reference of the 10 Canadian provinces and three territories, focusing on general eligibility criteria for home oxygen (including blood gas criteria, and eligibility criteria for ambulatory and nocturnal oxygen), and compared the eligibility criteria to the widely accepted criteria of the Nocturnal Oxygen Therapy Trial (NOTT) trial, the clinical recommendations of the Canadian Thoracic Society and the results of Cochrane reviews. The terms of reference for nine provinces were retrieved. All jurisdictions have similar criteria for long-term oxygen therapy, with slight differences in the thresholds of prescription and the clinical criteria defining 'p...
Utility Scores In Patients With Oxygen-Dependent COPD: A Case-Control Study
COPD, Jan 16, 2015
Utility measures that summarize the health-related quality of life of an individual using a singl... more Utility measures that summarize the health-related quality of life of an individual using a single number usually between 0 (death) and 1 (full health) are useful to quantify the benefits of health care interventions in terms of quality-adjusted life years (QALYs) and to help prioritizing limited health resources from cost-effectiveness analyses among patients with different health conditions. To determine utility scores in patients with oxygen-dependent chronic obstructive pulmonary disease (COPD). Patients with oxygen-dependent COPD (the cases) were matched, on a 1:2 basis, to COPD controls according to gender, age (± 5 years) and FEV1 (±5% predicted). Utility scores were obtained from the SF-6D, a measure derived from the SF-36. From a cohort of 102 patients with oxygen-dependent COPD, 68 (42 men; mean age: 71 years; mean FEV1: 35% predicted) were successfully matched with 136 controls. We found clinically and statistically significant differences in mean utility scores between c...
Obesity in chronic obstructive pulmonary disease: is fatter really better?
Canadian respiratory journal : journal of the Canadian Thoracic Society
Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon r... more Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon referred to as the 'obesity paradox'. To investigate whether the obesity paradox in patients with chronic obstructive pulmonary disease (COPD) is due to fat accumulation or confounding factors. A total of 190 patients with stable COPD who underwent a mean (± SD) follow-up period of 72±34 months were enrolled. Anthropometry, pulmonary function tests, midthigh muscle cross-sectional area obtained using computed tomography (MTCSACT), arterial blood gas and exercise testing data were measured at baseline. Patients were categorized into two subgroups according to body mass index (BMI) <25 kg⁄m2 or ≥25 kg⁄m2 (normal and overweight⁄obese, respectively). Seventy-two patients (38%) died during the follow-up period. Survival tended to be better in the overweight⁄obese patients but this difference did not reach statistical significance. Overweight⁄obese patients had better lung function a...
Canadian respiratory journal : journal of the Canadian Thoracic Society
A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease... more A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease (COPD) with advantages of both generic- and disease-specific questionnaires is needed to capture patients' perspectives of severity and impact of the disease. The McGill COPD questionnaire was created to include these advantages in English and French. It assesses three domains: symptoms, physical function and feelings with 29 items (12 from the 36-item Short-Form Health Survey with 17 from the previously developed COPD-specific module). To evaluate the psychometric properties of this newly developed hybrid questionnaire in subjects with COPD. Data from a multicentre, prospective cohort study involving four hospitals with COPD subjects undergoing pulmonary rehabilitation were used. Patient evaluations included health-related quality of life (the new McGill COPD questionnaire, the St Georges Respiratory Questionnaire and the 36-item Short-Form Health Survey) and pulmonary function tes...
Background: Attention deficit hyperactivity disorder is increased in children with intellectual d... more Background: Attention deficit hyperactivity disorder is increased in children with intellectual disability. Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks. Method: One hundred and twenty two drug-free children aged 7-15 with hyperkinetic disorder and IQ 30-69 were recruited to a double-blind, placebo-controlled trial that randomized participants using minimization by probability, stratified by referral source and IQ level in a one to one ratio. Methylphenidate was compared with placebo. Dose titration comprised at least 1 week each of low (0.5 mg/kg/day), medium (1.0 mg/kg/day) and high dose (1.5 mg/kg/day). Parent and teacher Attention deficit hyperactivity disorder (ADHD) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures. Clinical response was determined with the Clinical Global Impressions scale (CGI-I). Adverse effects were evaluated by a parent-rated questionnaire, weight, pulse and blood pressure. Analyses were by intention to treat. Results: Methylphenidate was superior to placebo with effect sizes of 0.39 [95% confidence intervals (CIs) 0.09, 0.70] and 0.52 (95% CIs 0.23, 0.82) for the parent and teacher Conners ADHD index. Four (7%) children on placebo versus 24 (40%) of those on methylphenidate were judged improved or much improved on the CGI. IQ and autistic symptoms did not affect treatment efficacy. Active medication was associated with sleep difficulty, loss of appetite and weight loss but there were no significant differences in pulse or blood pressure. Conclusions: Optimal dosing of methylphenidate is practical and effective in some children with hyperkinetic disorder and intellectual disability. Adverse effects typical of methylphenidate were seen and medication use may require close monitoring in this vulnerable group.
A Canadian, multicentre, randomized clinical trial of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease: rationale and methods
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is ... more Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation. To report the rationale and methods of a trial comparing the effectiveness of self-monitored, home-based rehabilitation with hospital-based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD). A parallel-group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD. Patients will be randomly assigned to conventional, supervised, hospital-based outpatient rehabilitation or self-monitored, home-based rehabilitation. Both interventions will include a standardized, comprehensive self-management program, in addition to the hospital-based outpatient or home-based exercise program. After the three-month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthly ...
New Strategy of Intervention Using a Written Action Plan in COPD: Early Treatment of Exacerbation Reduces Symptom Recovery Time
COPD GOLD stage 1: Is it really a disease?
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2011
Use of medication for challenging behaviour in people with intellectual disability
The British journal of psychiatry : the journal of mental science, 2014
ABSTRACT Medications, particularly antipsychotics, are commonly used to manage challenging behavi... more ABSTRACT Medications, particularly antipsychotics, are commonly used to manage challenging behaviour in people with intellectual disability. When the behaviour does not arise from an underlying mental illness, this is commonly off-licence and evidence of efficacy is lacking. A national audit programme would be one way to address the concerns this raises.
A Survey of Neural Tube Defect Pregnancies in North-West England
European Journal of Pediatric Surgery, 1988
The preliminary results are reported of the first eighteen months of a three year survey of NTD a... more The preliminary results are reported of the first eighteen months of a three year survey of NTD affected pregnancies in the North Western Region of England. The results are consistent with a general decline in the incidence of NTD. Prenatal screening has been available for 10 years but babies continue to be born with NTD. Supportive services are often lacking for parents having had an affected pregnancy and methods of imparting advice regarding recurrence risks have been shown to be variable and not always efficient.
Epilepsy in childhood: effects on behaviour and mental health
Introduction to Epilepsy, 2012
Mental health needs of children and young people with learning disabilities
The importance of family: a case report
Advances in Mental Health and Learning Disabilities, 2010
This case report highlights the importance of the role of the family in supporting a young person... more This case report highlights the importance of the role of the family in supporting a young person with a developmental disability. The young person discussed has a complex neurodevelopmental disorder with co-morbid physical health problems. Her family have coped with a number of events in CR&amp;amp;amp;amp;amp;#39;s life, ensuring that she has always had their support and understanding. At the time
Parents with learning disabilities ‐ the assessment of parenting ability
Advances in Mental Health and Learning Disabilities, 2007
There is increasing awareness of the needs of parents who have a learning disability with the emp... more There is increasing awareness of the needs of parents who have a learning disability with the emphasis being on the requirement to provide ‘good enough’ parenting to their children. This paper explores these issues and considers how these parenting needs might be addressed.
Psychiatric Bulletin, 1998
The role of the psychiatrist in learning disability: How it is perceived by the general practitioner
Psychiatric Bulletin, 1994
This study assessed, by postal questionnaire, how the role of the psychiatrist in learning disabi... more This study assessed, by postal questionnaire, how the role of the psychiatrist in learning disability is perceived by general practitioners. One hundred and forty-six GPs were questioned on various aspects of assessment and management that the psychiatrist in learning disability might be involved with; 43.5% of questionnaires were returned. The resultsindicated that confusion continues. The psychiatrist was perceived as having
Obesity and Chronic Obstructive Pulmonary Disease: Is Fatter Really Better?
Canadian Respiratory Journal, 2014
Lactate Kinetics during Exercise in Chronic Obstructive Pulmonary Disease
Canadian Respiratory Journal, 1997
Clinical Investigative Medicine, Jun 1, 2007
The goal of the present study was to compare the maximum walking speed and peak oxygen consumptio... more The goal of the present study was to compare the maximum walking speed and peak oxygen consumption (VO2 peak) obtained during the 6min walk test (6 MWT) and an incremental shuttle walking test (ISWT) in a trained older population. Methods: A total of 22 older adults (16 female and 6 male) with a group mean age of 70±5.8 yr (range 58 to 79) completed the 6 MWT and ISWT within a 2 wk period. Heart rate (HR) and VO2 peak were measured during each test with a portable metabolic cart (Cosmed, K4B2). The VO2 peak, the maximum walking speed and the total distance walked measured during both tests (6 MWT and ISWT) were compared. Results: A total of 110 recordings for the VO2 peak were obtained and analyzed. Strong correlations were found for the VO2 peak and the walking speed (r=0.91 and r=0.89, respectively, for 6 MWT and ISWT). VO2 peak values obtained with the ISWT were significantly greater (P<0.05) than with the 6 MWT (21.6 ± 5.3 vs 18.9 ml/kgmin ± 4.5, respectively). There was no difference between sexes. In addition, the maximum heart rate as predicted from age during the ISWT was reached by all participants while it was not during the 6 MWT. Conclusion: Thus, the ISWT appears to a better tool to assess the maximal aerobic functional capacity in older healthy adults based on the higher VO2 peak values obtained in comparison to the 6 MWT. status. Conclusion: This cohort of patients remained remarkably stable over a 2-year follow-up period. A small loss in lean body mass was observed in some patients but this could not be associated with adverse clinical outcomes during this period.
Eligibility for home oxygen programs and funding across Canada
Canadian respiratory journal : journal of the Canadian Thoracic Society, Jan 25, 2015
In Canada, although medical insurance is generally universal, significant differences exist in th... more In Canada, although medical insurance is generally universal, significant differences exist in the provision of home oxygen therapy across the country. To systematically compare the terms of reference for home oxygen across Canada, with a focus on the clinical inclusion criteria to the programs. The authors searched the terms of reference of the 10 Canadian provinces and three territories, focusing on general eligibility criteria for home oxygen (including blood gas criteria, and eligibility criteria for ambulatory and nocturnal oxygen), and compared the eligibility criteria to the widely accepted criteria of the Nocturnal Oxygen Therapy Trial (NOTT) trial, the clinical recommendations of the Canadian Thoracic Society and the results of Cochrane reviews. The terms of reference for nine provinces were retrieved. All jurisdictions have similar criteria for long-term oxygen therapy, with slight differences in the thresholds of prescription and the clinical criteria defining 'p...
Utility Scores In Patients With Oxygen-Dependent COPD: A Case-Control Study
COPD, Jan 16, 2015
Utility measures that summarize the health-related quality of life of an individual using a singl... more Utility measures that summarize the health-related quality of life of an individual using a single number usually between 0 (death) and 1 (full health) are useful to quantify the benefits of health care interventions in terms of quality-adjusted life years (QALYs) and to help prioritizing limited health resources from cost-effectiveness analyses among patients with different health conditions. To determine utility scores in patients with oxygen-dependent chronic obstructive pulmonary disease (COPD). Patients with oxygen-dependent COPD (the cases) were matched, on a 1:2 basis, to COPD controls according to gender, age (± 5 years) and FEV1 (±5% predicted). Utility scores were obtained from the SF-6D, a measure derived from the SF-36. From a cohort of 102 patients with oxygen-dependent COPD, 68 (42 men; mean age: 71 years; mean FEV1: 35% predicted) were successfully matched with 136 controls. We found clinically and statistically significant differences in mean utility scores between c...
Obesity in chronic obstructive pulmonary disease: is fatter really better?
Canadian respiratory journal : journal of the Canadian Thoracic Society
Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon r... more Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon referred to as the 'obesity paradox'. To investigate whether the obesity paradox in patients with chronic obstructive pulmonary disease (COPD) is due to fat accumulation or confounding factors. A total of 190 patients with stable COPD who underwent a mean (± SD) follow-up period of 72±34 months were enrolled. Anthropometry, pulmonary function tests, midthigh muscle cross-sectional area obtained using computed tomography (MTCSACT), arterial blood gas and exercise testing data were measured at baseline. Patients were categorized into two subgroups according to body mass index (BMI) <25 kg⁄m2 or ≥25 kg⁄m2 (normal and overweight⁄obese, respectively). Seventy-two patients (38%) died during the follow-up period. Survival tended to be better in the overweight⁄obese patients but this difference did not reach statistical significance. Overweight⁄obese patients had better lung function a...
Canadian respiratory journal : journal of the Canadian Thoracic Society
A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease... more A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease (COPD) with advantages of both generic- and disease-specific questionnaires is needed to capture patients' perspectives of severity and impact of the disease. The McGill COPD questionnaire was created to include these advantages in English and French. It assesses three domains: symptoms, physical function and feelings with 29 items (12 from the 36-item Short-Form Health Survey with 17 from the previously developed COPD-specific module). To evaluate the psychometric properties of this newly developed hybrid questionnaire in subjects with COPD. Data from a multicentre, prospective cohort study involving four hospitals with COPD subjects undergoing pulmonary rehabilitation were used. Patient evaluations included health-related quality of life (the new McGill COPD questionnaire, the St Georges Respiratory Questionnaire and the 36-item Short-Form Health Survey) and pulmonary function tes...
Background: Attention deficit hyperactivity disorder is increased in children with intellectual d... more Background: Attention deficit hyperactivity disorder is increased in children with intellectual disability. Previous research has suggested stimulants are less effective than in typically developing children but no studies have titrated medication for individual optimal dosing or tested the effects for longer than 4 weeks. Method: One hundred and twenty two drug-free children aged 7-15 with hyperkinetic disorder and IQ 30-69 were recruited to a double-blind, placebo-controlled trial that randomized participants using minimization by probability, stratified by referral source and IQ level in a one to one ratio. Methylphenidate was compared with placebo. Dose titration comprised at least 1 week each of low (0.5 mg/kg/day), medium (1.0 mg/kg/day) and high dose (1.5 mg/kg/day). Parent and teacher Attention deficit hyperactivity disorder (ADHD) index of the Conners Rating Scale-Short Version at 16 weeks provided the primary outcome measures. Clinical response was determined with the Clinical Global Impressions scale (CGI-I). Adverse effects were evaluated by a parent-rated questionnaire, weight, pulse and blood pressure. Analyses were by intention to treat. Results: Methylphenidate was superior to placebo with effect sizes of 0.39 [95% confidence intervals (CIs) 0.09, 0.70] and 0.52 (95% CIs 0.23, 0.82) for the parent and teacher Conners ADHD index. Four (7%) children on placebo versus 24 (40%) of those on methylphenidate were judged improved or much improved on the CGI. IQ and autistic symptoms did not affect treatment efficacy. Active medication was associated with sleep difficulty, loss of appetite and weight loss but there were no significant differences in pulse or blood pressure. Conclusions: Optimal dosing of methylphenidate is practical and effective in some children with hyperkinetic disorder and intellectual disability. Adverse effects typical of methylphenidate were seen and medication use may require close monitoring in this vulnerable group.
A Canadian, multicentre, randomized clinical trial of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease: rationale and methods
Canadian respiratory journal : journal of the Canadian Thoracic Society
Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is ... more Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation. To report the rationale and methods of a trial comparing the effectiveness of self-monitored, home-based rehabilitation with hospital-based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD). A parallel-group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD. Patients will be randomly assigned to conventional, supervised, hospital-based outpatient rehabilitation or self-monitored, home-based rehabilitation. Both interventions will include a standardized, comprehensive self-management program, in addition to the hospital-based outpatient or home-based exercise program. After the three-month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthly ...
New Strategy of Intervention Using a Written Action Plan in COPD: Early Treatment of Exacerbation Reduces Symptom Recovery Time
COPD GOLD stage 1: Is it really a disease?
COPD: Journal of Chronic Obstructive Pulmonary Disease, 2011